Maternity Nursing: Postpartum Q 38
After the expulsion of the placenta in a client who has six living children, an infusion of lactated ringer’s solution with 10 units of Pitocin is ordered. The nurse understands that this is indicated for this client because:
A. She had a precipitate birth
B. This was an extramural birth
C. Retained placental fragments must be expelled
D. Multigravidae are at increased risk for uterine atony
Correct Answer: D. Multigravidas are at increased risk for uterine atony.
Multiple full-term pregnancies and deliveries result in overstretched uterine muscles that do not contract efficiently and bleeding may ensue. Risk factors for uterine atony include prolonged labor, precipitous labor, uterine distension (multifetal gestation, polyhydramnios, fetal macrosomia), fibroid uterus, chorioamnionitis, indicated magnesium sulfate infusions, and prolonged use of oxytocin.
Option A: The woman did not have precipitate labor. Contraction of the myometrium that mechanically compresses the blood vessels supplying the placental bed provides the principal mechanism uterine hemostasis after delivery of the fetus, and the placenta is concluded. The process is complemented by local decidual hemostatic factors such as tissue factor type-1 plasminogen activator inhibitors as well as by systemic coagulation factors such as platelets, circulating clotting factors.
Option B: In obstetrical, midwifery, and public health scholarship, “extramural” can describe any birth outside a childbirth facility. More often, it means a birth both outside and intended, sanctioned location and without the supervision of a skilled birth attendant. It is not indicated in the situation that the woman gave birth outside a healthcare facility.
Option C: An expeditious exclusion of retained gestational products or obstetric lacerations quickly excludes additional co-concomitant etiologies. Uterine atony refers to the corpus uteri myometrial cells inadequate contraction in response to endogenous oxytocin that is released in the course of delivery. It leads to postpartum hemorrhage as delivery of the placenta leaves disrupted spiral arteries which are uniquely void of musculature and dependent on contractions to mechanically squeeze them into a hemostatic state. Uterine atony is a principal cause of postpartum hemorrhage, an obstetric emergency. Globally, this is one of the top 5 causes of maternal mortality.